title: Comparison of clinical features in patients with persistent and nonpersistent cryptococcal meningitis: twelve years of clinical experience in four centers in China.
abstract: OBJECTIVE
  Cryptococcal meningitis (CM) has gradually increased in the recent 20 years in the whole world. Although the mortality decreased significantly in recent years, it was still high, especially in patients with persistent infection. Therefore, we compare differences of clinical features between persistent and nonpersistent CM patients.
  
  
  METHODS
  We conducted a retrospective review of medical records of patients diagnosed with CM from January 2000 to December 2011 in four centers in China, including demographic features, underlying diseases, clinical presentations, laboratory data, and so on.
  
  
  RESULTS
  Of 106 CM patients enrolled, 16 were identified as persistent cases. Among all variables, persistent CM patients were more like to be human immunodeficiency viruses (HIV) infection (P < 0.05), stiff neck (P < 0.01), a serum hemoglobin < 90 g/L (P < 0.01), a serum potassium concentration <2.7 mg/L (P < 0.01), an intracranial pressure (ICP) >400 mmH2 O (P < 0.01), and a latex agglutination cryptococcal antigen titer of cerebrospinal fluid (CSF LACT) >1:1024 (P < 0.01) than nonpersistent ones. A multivariate analysis showed that HIV infection (OR 7.49), stiff neck (OR 11.7), a serum potassium <2.7 mmol/L (OR 9.45), and an ICP >400 mmH2 O (OR 6.83) were closely correlated with persistent CM.
  
  
  CONCLUSIONS
  Although it is difficult to deal with persistent CM nowadays, some cases could be predicted early enough in the future, so as to be treated appropriately and have relatively good outcomes.
authors.affiliation: Shanghai Key Laboratory of Molecular Medical Mycology, PLA Key Laboratory of Mycosis, Institute of Dermatology and Mycosis of Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Xiao-Guang
authors.initials: XG
authors.lastname: Xu
authors.forename: Wei-Hua
authors.initials: WH
authors.lastname: Pan
authors.forename: Xin-Ling
authors.initials: XL
authors.lastname: Bi
authors.forename: Wei
authors.initials: W
authors.lastname: Fang
authors.forename: Min
authors.initials: M
authors.lastname: Chen
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhu
authors.forename: Jie
authors.initials: J
authors.lastname: Zhou
authors.forename: Nan
authors.initials: N
authors.lastname: Zhou
authors.forename: Bo
authors.initials: B
authors.lastname: Pan
authors.forename: Meng
authors.initials: M
authors.lastname: Li
authors.forename: Wan-Qing
authors.initials: WQ
authors.lastname: Liao
authors.forename: Zhong-Tian
authors.initials: ZT
authors.lastname: Qi
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis* / Q000453:epidemiology* / Q000378:metabolism; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: Clinical features; Cryptococcal; HIV; Intracranial pressure; Meningitis; Persistent infection